Download PDF
Am J Perinatol
DOI: 10.1055/s-0043-1761297
Original Article

Differences When Classifying Small for Gestational Age Preterm Infants According to the Growth Chart Applied

Javier Estañ-Capell 
1   Neonatal Unit, Hospital Clínico Universitario, Valencia, Spain
2   Department of Pediatrics, School of Medicine, University of Valencia, Valencia, Spain
,
Beatriz Alarcón-Torres 
1   Neonatal Unit, Hospital Clínico Universitario, Valencia, Spain
,
Magdalena Miró-Pedro
1   Neonatal Unit, Hospital Clínico Universitario, Valencia, Spain
,
Cecilia Martínez-Costa
2   Department of Pediatrics, School of Medicine, University of Valencia, Valencia, Spain
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objective Consensus around the ideal chart to classify preterm babies is scant. It is particularly relevant in small for gestational age (SGA) infants due to its clinical and therapeutic implications. The aim of the study was to compare Olsen, Intergrowth-21st, and Fenton growth charts, regarding the classification at birth and incidence of SGA preterm infants.

Study Design Retrospective study of 529 preterm infants ≤ 32 weeks of gestational age. Birth weight Z-score was calculated applying the three growth charts and ponderal index (PI) was also estimated. Incidence of SGA (birth weight < 10th percentile) and clinical outcome were compared according to the chart used.

Results Incidence of SGA was significantly higher (p < 0.001) with Olsen (101 cases, 19.1%) compared with Intergrowth-21st (75 cases, 14.2%) and Fenton (53 cases, 10%). Differences were also found with PI of SGA preterm infants, as those infants classified by Olsen were mostly symmetric (PI > 10th percentile), while Fenton and Intergrowth-21st identified less symmetric SGA infants. Kappa concordance between Intergrowth-21st and Fenton was 0.805, Intergrowth-21st versus Olsen 0.824, and Fenton versus Olsen 0.641. No differences were observed on neonatal morbidities or mortality.

Conclusion Significant differences were detected when classifying very preterm infants at birth according to the growth chart, mainly among symmetric SGA. Concordance between Fenton and Olsen was poor, but Intergrowth-21st showed high concordance with Fenton and Olsen. However, further research is needed to select the ideal chart. Variability in the population selected to create the curves and the accuracy dating the pregnancy are factors that may have explained differences.

Key Points

  • Very preterm infants are differently classified at birth with various growth charts.

  • Higher incidence of small for gestational age infants with Olsen compared with Fenton or Intergrowth.

  • Variability in population selection and accuracy in dating pregnancy may have explained differences.

Keywords

growth charts - birth weight - preterm infants - small for gestational age

Authors' Contributions

All authors have accepted responsibility for the entire content of this manuscript and approved its submission.


Ethical Approval

This research involved the use of existing medical records that contain only non-identifiable data about human beings and was approved by the Hospital Ethics Committee.


Supplementary Material



Publication History

Received: 21 January 2022

Accepted: 15 December 2022

Article published online:
29 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Cordova EG, Belfort MB. Updates on assessment and monitoring of the Postnatal growth of preterm infants. Neoreviews 2020; 21 (02) e98-e108
    Google Scholar
  • 2 Kozuki N, Katz J, Christian P. et al; Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group. Comparison of US birth weight references and the International Fetal and Newborn Growth Consortium for the 21st century standard. JAMA Pediatr 2015; 169 (07) e151438
    CrossrefPubMedGoogle Scholar
  • 3 Boghossian NS, Geraci M, Edwards EM, Horbar JD. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks' gestation. Pediatrics 2018; 141 (02) e20172533
    Google Scholar
  • 4 Clark RH, Olsen IE, Spitzer AR. Assessment of neonatal growth in prematurely born infants. Clin Perinatol 2014; 41 (02) 295-307
    Google Scholar
  • 5 Kajdy A, Modzelewski J, Filipecka-Tyczka D, Pokropek A, Rabijewski M. Development of birth weight for gestational age charts and comparison with currently used charts: defining growth in the polish population. J Matern Fetal Neonatal Med 2019; 16: 1-8
    PubMedGoogle Scholar
  • 6 Marques B, Martins R, Rodrigues T, Oliveira G, Abrantes M. Performance of Intergrowth 21st growth charts in the diagnosis of small and large for gestational age in term and preterm newborns. Acta Med Port 2019; 33: 15-21
    CrossrefPubMedGoogle Scholar
  • 7 Ohuma EO, Altman DG. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st Project). Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts. Stat Med 2019; 38 (19) 3527-3539
    CrossrefPubMedGoogle Scholar
  • 8 de Onis M, Garza C, Onyango AW, Borghi E. Comparison of the WHO child growth standards and the CDC 2000 growth charts. J Nutr 2007; 137 (01) 144-148
    CrossrefPubMedGoogle Scholar
  • 9 de Onis M, Siyam A, Borghi E, Onyango AW, Piwoz E, Garza C. Comparison of the World Health Organization growth velocity standards with existing US reference data. Pediatrics 2011; 128 (01) e18-e26
    CrossrefPubMedGoogle Scholar
  • 10 Bertino E, Milani S, Fabris C, De Curtis M. Neonatal anthropometric charts: what they are, what they are not. Arch Dis Child Fetal Neonatal Ed 2007; 92 (01) F7-F10
    CrossrefPubMedGoogle Scholar
  • 11 Anderson NH, Sadler LC, McKinlay CJD, McCowan LME. INTERGROWTH-21st vs customized birthweight standards for identification of perinatal mortality and morbidity. Am J Obstet Gynecol 2016; 214 (04) 509.e1-509.e7
    CrossrefPubMedGoogle Scholar
  • 12 Ayerza Casas A, Rodríguez Martínez G, Samper Villagrasa MP, Ventura Faci P. To born small for gestational age may depend on the growth curve used [in Spanish]. Nutr Hosp 2011; 26 (04) 752-758
    PubMedGoogle Scholar
  • 13 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 14 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (02) e214-e224
    Google Scholar
  • 15 Villar J, Cheikh Ismail L, Victora CG. et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014; 384 (9946): 857-868
    CrossrefPubMedGoogle Scholar
  • 16 Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH. INTERGROWTH-21st Consortium. INTERGROWTH-21st very preterm size at birth reference charts. Lancet 2016; 387 (10021): 844-845
    CrossrefPubMedGoogle Scholar
  • 17 Liu S, Metcalfe A, León JA, Sauve R, Kramer MS, Joseph KS. Canadian Perinatal Surveillance System (Public Health Agency of Canada). Evaluation of the INTERGROWTH-21st project newborn standard for use in Canada. PLoS One 2017; 12 (03) e0172910
    CrossrefPubMedGoogle Scholar
  • 18 Tuzun F, Yucesoy E, Baysal B, Kumral A, Duman N, Ozkan H. Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants. J Matern Fetal Neonatal Med 2018; 31 (17) 2252-2257
    CrossrefPubMedGoogle Scholar
  • 19 Pimenta JRR, Grandi C, Aragon DC, Cardoso VC. Comparison of birth weight, length, and head circumference between the BRISA-RP and Intergrowth-21st cohorts. J Pediatr (Rio J) 2020; 96 (04) 511-519
    CrossrefPubMedGoogle Scholar
  • 20 Bendor-Samuel OM, Zivanovic S, Odd D, Roehr CC. A comparison of UK preterm anthropometric charts and INTERGROWTH-21st: is it time to change growth charts?. Neonatology 2020; 117 (03) 300-307
    CrossrefPubMedGoogle Scholar
  • 21 Samarani M, Restom G, Mardini J, Abi Fares G, Hallit S, Fadous Khalife M-C. Comparative study between Fenton and intergrowth 21 charts in a sample of Lebanese premature babies. BMC Pediatr 2020; 20 (01) 74
    CrossrefPubMedGoogle Scholar
  • 22 Reddy KV, Sharma D, Vardhelli V, Bashir T, Deshbotla SK, Murki S. Comparison of Fenton 2013 growth curves and Intergrowth-21 growth standards to assess the incidence of intrauterine growth restriction and extrauterine growth restriction in preterm neonates ≤32 weeks. J Matern Fetal Neonatal Med 2021; 34 (16) 2634-2641
    CrossrefPubMedGoogle Scholar
  • 23 González-García L, García-López E, Fernández-Colomer B. et al. Extrauterine growth restriction in very low birth weight infants: concordance between Fenton 2013 and INTERGROWTH-21st growth charts. Front Pediatr 2021; 9: 690788
    CrossrefPubMedGoogle Scholar
  • 24 Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119 (03) 417-423
    CrossrefPubMedGoogle Scholar
  • 25 Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from live born birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963; 32: 793-800
    CrossrefPubMedGoogle Scholar
  • 26 Landmann E, Reiss I, Misselwitz B, Gortner L. Ponderal index for discrimination between symmetric and asymmetric growth restriction: percentiles for neonates from 30 weeks to 43 weeks of gestation. J Matern Fetal Neonatal Med 2006; 19 (03) 157-160
    CrossrefPubMedGoogle Scholar
  • 27 Olsen IE, Lawson ML, Meinzen-Derr J. et al. Use of a body proportionality index for growth assessment of preterm infants. J Pediatr 2009; 154 (04) 486-491
    Google Scholar
  • 28 Boghossian NS, Geraci M, Edwards EM, Horbar JD. Neonatal and fetal growth charts to identify preterm infants <30 weeks gestation at risk of adverse outcomes. Am J Obstet Gynecol 2018; 219 (02) 195.e1-195.e14
    CrossrefPubMedGoogle Scholar
  • 29 Vieira MC, Relph S, Copas A. et al; DESiGN Collaborative Group. The DESiGN trial (DEtection of Small for Gestational age Neonate), evaluating the effect of the Growth Assessment Protocol (GAP): study protocol for a randomised controlled trial. Trials 2019; 20 (01) 154
    CrossrefPubMedGoogle Scholar
  • 30 Bhatia J. Growth curves: how to best measure growth of the preterm infant. J Pediatr 2013; 162 (3, Suppl): S2-S6
    CrossrefPubMedGoogle Scholar
  • 31 Boghossian NS, Geraci M, Edwards EM, Morrow KA, Horbar JD. Anthropometric charts for infants born between 22 and 29 weeks' gestation. Pediatrics 2016; 138 (06) e20161641
    CrossrefPubMedGoogle Scholar
  • 32 Pearson F, Johnson MJ. How should we chart the growth of very preterm babies?. Arch Dis Child Fetal Neonatal Ed 2019; 104 (02) F120-F121
    CrossrefPubMedGoogle Scholar
  • 33 Aris IM, Kleinman KP, Belfort MB, Kaimal A, Oken E. A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation. Pediatrics 2019; 144 (01) e20190076
    CrossrefPubMedGoogle Scholar
  • 34 Clark RH, Olsen IE. Do we need another set of growth charts for premature infants?. Pediatrics 2016; 138 (06) e20163128
    CrossrefPubMedGoogle Scholar
  • 35 Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res 2020; 22 (01) e16204
    CrossrefPubMedGoogle Scholar
  • 36 Barreto CM, Pereira MAL, Rolim ACB, Abbas SA, Langhi Junior DM, Santos AMND. Incidence of small for gestational age neonates, according to the Fenton and Intergrowth-21st curves in a level II maternity. Rev Paul Pediatr 2021; 39: e2019245
    CrossrefPubMedGoogle Scholar